Symptom Set.

December 14, 2017 (symptom set: first formal compilation)
Here is a set of symptoms that I experience.
Heart

General: All of my cardiac symptoms have subsided somewhat. Exercise seems to have a long-lasting impact on cardiac measures. Heart rate seems elevated for hours after light to moderate exercise. For this reason, I think that the measurements in medical settings have been exaggerated simply by virtue of traveling to the appointment (I don't have a car, so that usually involves walking). I recall a measurement a while ago with a heart rate of 120 and blood pressure of 90/50.

Tachycardia: My tachycardia has largely subsided. I think this is a result of things I've been doing. It may be my bias talking, but I think that my heart rate is usually higher when my blood pressure measures low. The 24 hour EKG I did a while ago found an average of 95 bpm, (1). It seems that 90 bpm, as opposed to the outdated 100 bpm, is generally agreed upon by experts as the threshold for tachycardia, (2,3).

Blood Pressure: My blood pressure is usually on the low side (e.g. 100/60). Occasionally it's been below that (e.g. 90/50), and rarely above that (e.g. 115/70). My pulse pressure is usually normal (i.e. 40), but it has been somewhat low on occasion (e.g. 90/60 == 30). It's been higher as well, but usually not by much, and it can be accounted for by variation in stimulation.


Brain

General: This set of symptoms seems the most dramatic in terms of day-to-day variation. Presumably, this is because of variation in sleep.

Personality: Generally, my personality is quite autistic. In my case, I think that this is largely mediated by sleep, and is therefore a non-constant. I think that whether autism in general is a sleep disorder is up for debate.

Mood: I perhaps have fluctuations in mood. This is partly associated with subjective energy levels. Tachycardia tends to improve my mood, though it can also be uneasy at times. Sometimes when I was feeling artificially good and energetic, I'd check my heart and it would read 115-125 bpm.

My mood appears to have a circadian rhythm: good mood in the evening, and poor mood at night. I believe this may have to do with low blood pressure. I've measured my blood pressure a couple times when I was feeling weird, and tested low. Again, it's plausibly my confirmation bias that is saying so.

Sleep Anxiety: I'm generally a pretty chill person, but I can experience sleep anxiety (anxiety about falling asleep). However, I don't always experience it. I've had some experiences with several hours of relaxing sleep onset latencies.

Forgetfulness: I find myself forgetting simple vocabulary. The words don't come to me 'till perhaps a couple days after the fact. Additionally, I can walk into rooms and forget what I'm doing, or open google and forget what to search. However, this particular symptom is hard to gauge in comparison to the general population.

Mental sluggishness: In addition to my vocabulary faltering altogether, It can take extended periods to articulate a sentence. Nevertheless, I am, of course, meticulous. I have delayed response times, and periods of collecting my thoughts.


Skin

Dry skin: If I had to characterize my skin, I would say it's dry. In the past, I've had this issue where the skin around my nose becomes dry and peels. It seems to appear mostly during the summer. I think I've resolved this, but I suppose I'll have to wait and see. I've also had small bits of skin peel on my fingertips, arms, and legs.

Circles under eyes: I've not yet fully grasped the underpinnings of dark circles. Naturally, sleep deprivation is one cause. As I understand it, this is downstream of stress hormones. It can also simply be genetic (e.g. thin skin under eyes).

Temperature

General: Subjectively, I feel cold more often than I feel hot. Nevertheless, my thermal preferences aren't necessarily driven by that fact.

Cold: I like the cold more than I like heat. However, I find slightly cold temperatures to be very chilling. It is at extreme cold that I usually find comfort, though it becomes challenging and/or painful to move my fingers. My working theory is that, since thermoreceptors sense change in temperature, matching my periphery to the environment limits the sensation. I've since found resolution by using warm garments peripherally, which presumably keeps blood flowing.

Heat: I find heat very bothersome. Heat, naturally, will speed up heart rate and lower blood pressure via vasodilation.

Body Temp: My central body temperature generally appears slightly elevated, though within normal limits (e.g. 99F). However, my periphery is normally quite cold. I can often tell when I shake someone's hand because my hands are so much colder than theirs. This may be due to lack of warm clothing rather than something internal. Also, I think the cold periphery explains the heightened internal temperature, since cold causes the body to conserve heat.

I recall one time in particular where my body temperature was high but my hands were freezing. I was trying out seeing a naturopath to see if they might be helpful. They took my temperature, and it was high. When I shook their hands it was evident that my hands were cold. This may all have been due to me not wearing a jacket. I usually don't like jackets; they make me uncomfortable.

Sweat: I used to experience sweating while feeling cold, but it's been a while since that last happened. I think it was caused by elevated stress hormones. Both sleep deprivation and missing meals seemed to exacerbate it. During the day, I would avoid warm garments because of the discomfort of sweating. At night it would become an issue because I found it hard to get warm enough, yet also kept sweating. As I said, these have mostly subsided, probably because of reductions in physiological stressors as a result of some of the things I've been doing.


Other:

Appetite: I have a major problem eating enough. There was a period where I was trying to get in 2000 calories every day, and found it quite challenging. Junk food makes calorie consumption quite a bit easier. The standard calculation estimates my basal metabolic rate at about 1600Kcal per day.

Thirst: I'm quite thirsty. My natural level of thirst causes me to drink several liters of water a day. I also usually carry water around with me. That level of intake is by no means excessive, but I believe that the frequency of intake could be.

Circadian: My phenotype is typically that of an extended circadian period (and corresponding late chronotype). Generally, I've found zeitgebers such as melatonin, blue light in the morning, and blue blocking glasses at night to be inadequate.

Paradoxical: Severe sleep deprivation increases my subjective alertness. Caffeine sometimes makes me sleepy, particularly if I've accrued a sleep debt. Likewise, depressants can make me agitated. I attribute most of these paradoxical effects to autonomic tone as it relates to the heart. For example, caffeine's ability to lower heart rate could explain the sedation. (4,5).


Hydroxyzine update:
I have been taking 350mg of hydroxyzine for a couple weeks or so. It seemed to make a dramatic difference, particularly at the start. Also, I've started taking it 3-5 hours before bed, as it doesn't really seem to kick in for some time. It's possible that this is caused by rate limited absorption or rate limited blood-brain barrier permeability. However, I think it's more likely that it is assisting in the nocturnal drop in stress hormones like e.g. cortisol. Normal subjects experience a dip in cortisol a couple hours prior to sleep onset, while insomniacs fail to express this drop, (6). More interestingly, this elevated evening cortisol can be experimentally induced the following evening after sleep deprivation, (7). Therefore, it seems likely that insomnia instigates the cycle, rather than the other way around. I personally strongly associate with this research, since the less sleep I get the harder it is to fall asleep the next night. In any case, this is my proposed mechanism for why taking hydroxyzine so far in advance is effective. It's worth noting that the same dosing schedule was not very efficacious at lower doses.

For the first week or so at the higher dose, it had largely eliminated my tiredness. Now, my tiredness seems dependent on the previous night's sleep (i.e. good on some days, bad on others). Sleep onset latency is still radically reduced, and sleep urge is amplified. The unpleasantness and discomfort of falling asleep have also improved. I can't say that I'm entirely satisfied, but I can say that I'm entirely relieved. It has already remained effective for a long enough period to appear effective indefinitely.

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